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The Open Inflammation Journal, 2012, 5, 1-9 1

Open Access
Definition of Inflammation, Causes of Inflammation and Possible
Anti-inflammatory Strategies

Sran V. Stankov*

Pasteur Institute Novi Sad, Hajduk Veljkova 1, 21000 Novi Sad, Serbia

Abstract: Current definition of inflammation by its cardinal signs is obsolete and unsuitable for guiding adequate
therapeutic strategies. Furthermore, present theory of the inflammatory process regarding vascular phenomena as essential
for generation of cardinal signs is invalid and unable to explain well established empirical facts, particularly the extent of
the osmotic pressure and temperature variations within the inflamed tissue.
From five cardinal signs, there is actually just one specific macroscopic sign of inflammation, namely localized edema.
Further, the driving force for tissue fluid accumulation is defined in biochemical terms and as such taken for the definition
of the inflammatory process. Inflammation may be defined as a degenerative process which is intense enough to cause
local accumulation of low molecular weight catabolic products, which in turn elevates tissue osmotic pressure that attracts
extra fluid, with or without heat release sufficient for significant elevation of tissue temperature. This process is in a sharp
contrast to the pathogenesis of burns, where externally applied heat causes a process that is in essence opposite to
inflammation, bearing only some superficial similarities with the latter.
The inflammatory process is itself a pathological process, whereas the natural anti-inflammatory response that ensues
after acute inflammation tends to reverse tissue homeostasis towards normality and should therefore be regarded as a true
defensive reaction of the affected tissue.
Based on the therapeutic principle of reverse thermodynamics, heat application to the inflamed tissue is an obvious, yet
non-exclusive therapeutic choice that follows from the given universal definition of inflammation.

Keywords: Inflammation, catabolism, osmotic pressure, edema, anti-inflammatory response, burns.

INTRODUCTION apparent tolerance to microorganisms, and also vigorous


inflammation, i.e. hypersensitivity to noxious stimuli. Wide
Biological objects in life sciences are often observed and
variety of ambiguous terms in biology may be and often is
described while taking part in processes with various,
an inspiration for further experimental and theoretical work
sometimes even directly opposite outcomes, whereby these and development of biological sciences. However, from a
processes are named identically and according to the object
medical perspective ambiguous theoretical terms are a great
concerned. For example, activity of lactate dehydrogenase
obstacle because at one time and place, a process (physical,
is a name for a process that in reality includes both the
chemical or biological) may take only one direction.
oxidation of lactate to pyruvate and also its reverse process,
Therefore, in order to reliably predict the influence of a
reduction of pyruvate to lactate. Similarly, phagocytosis
given defined factor to a biological environment, one should
denotes a process of engulfment and full digestion of first unambiguously define its interaction with biological
bacteria by a phagocyte but also a process of engulfment of
objects as a unidirectional process. For example, the
bacteria by a phagocyte followed by reproduction of bacteria
biochemical term hydrolysis denotes only the process of
with resultant phagocyte lysis, i.e.eating the host cell by
disruption of bonds between monomeric units of
bacteria [1, 2]. On the organismal scale, the classical
biopolymers in presence of water and not vice versa. Since
meaning of immunity has been resistance to influences of
biochemical reactions between substrates generally satisfy
infectious agents, meaning in reality absence of this condition of unambiguousness, potential great benefits
inflammation in presence of a pathogenic microorganism.
to medical sciences from explicitly defining biological
However, one of the classical experimental models of
processes in terms of biochemical reactions between
causing inflammation is application of complete Freund
substrates are here exemplified by a biochemical definition
adjuvant (CFA), that is generally regarded as one of the
of the inflammatory process, an old, widely important but
strongest immunostimulators [3]. Thus, by immunity one
still controversial notion. Although the inflammatory process
usually understands both absence of inflammation as as a manifestation of disease has been recognized almost
from historical beginnings of medicine, its nature and
physiological significance have not become clear and
*Address correspondence to this author at the Pasteur Institute Novi Sad,
undisputed until present time. Here are some characteristic
Hajduk Veljkova 1, 21000 Novi Sad, Serbia; Tel: +381 21 6611003;
Fax: +381 21 6611003; Emails: stankov.paster@gmail.com, opinions. Most pathologists would probably agree that
Stankov.paster@ptt.rs inflammation represents a response of living tissue to local

1875-0419/12 2012 Bentham Open


2 The Open Inflammation Journal, 2012, Volume 5 Sran V. Stankov

injury [4] Inflammation: A basic way in which the body exudation of plasma into hepatic tissue, therefore such
reacts to infection, irritation or other injury, the key feature exudation cannot create any disbalance of oncotic forces and
being redness, warmth, swelling and pain. Inflammation is consequently cannot contribute to edema at least in hepatitis.
now recognized as a type of nonspecific immune response. Further, transcapillary exudation cannot explain appearances
[5] Inflammation is the basic process whereby tissues of the of cellular [16-19] and mitochondrial [20, 21] edema as
body respond to injury. [6] Although we have learned a lot primary phenomena in the course of inflammation. An
about the signaling pathways that link energy accumulation obvious proof that any circulatory mechanism is completely
[adiposity] to chronic inflammation, we know little about the unnecessary for inflammation is its appearance in avascular
real biological significance of the inflammation. [7] At tissues, e.g. in the cornea [22, 23] or in cartilage [24, 25].
present, inflammation is defined by the presence of five Looking at the development of experimental stromal keratitis
macroscopic pathological phenomena, four of them proposed it is obvious that disciform corneal edema might first appear
by Celsus as long as 2000 years ago. These are tumor - on any part of the cornea, depending on the location of the
swelling of the tissue, calor elevated tissue temperature, effect of the irritant applied [22, 23]. This is in sharp contrast
rubor blood color-like redness of vascularized tissue at the to first appearance of edema on the limbal area with
inflammation site, dolor intensive sensation of a noxious subsequent spread to the corneal center, something one
stimulus, and functio laesa, i.e. impaired function of the would expect had the edema been generated by changes in
organ affected [8, 9]. All signs have been regarded as the nearest vasculature. From an evolutionary perspective,
secondary to one primary pathophysiological event inflammation as represented by edema appears older than the
enhancement of vascular permeability as a direct blood circulatory system. Thus, swelling of perianal area
consequence of tissue injury [4, 10]. Meanwhile, modern upon infection by bacterium Microbacterium nematophilum
natural sciences have comprehensively elucidated biological in the nematode Caenorhabditis elegans [26], animal lacking
processes at the biochemical and molecular level that take
place in the course of the inflammatory process. In the
1940s, American pathologist Menkin defined the sixth
cardinal and at the same time the only essential biochemical
sign of inflammation, i.e. proteolysis [11]. However, the
significance of his discovery has been largely neglected,
leaving considerable confusion in explanations of the cause-
effect relationships in pathogenesis and in the approaches to
treatment of inflammatory diseases [12]. In particular, it is
very often noted that, although inflammation is a defensive,
therefore a useful process, its exaggeration or prolonged
action may harm the body. However, the reasons for such
outcomes are never explicitly stated.

DEFINITION OF INFLAMMATION
The Specificity of Cardinal Signs of Inflammation
Now, let us first look at the phenomena that are truly
specific to the inflammatory process. Of five classical signs,
pain and loss of function are present also with a degenerative
process. For example, both may be present when joints are
affected either by arthritis or arthrosis. Further, redness may
be present also with functional hyperemia, cutaneous tumors,
hemangioma, polycythemia, burns, etc. Elevated tissue
temperature may be observed with hyperthermia, burns or
functional hyperemia. Finally, edema that encompasses
major body parts appears with heart or kidney failure. That
leaves us with only one truly specific sign of inflammation,
i.e. localized edema. Increased vascular permeability per se,
often indicated as the immediate cause of inflammatory
edema [4, 10], cannot really be considered responsible for
several lines of evidence as follows. First, low molecular
weight (Mwt) substances account for the most part (over
98%) of the osmotic pressure in the extracellular as well as
the intracellular space [13]. Starling equation [14, 15], which
considers only capillary hydrostatic and oncotic pressures
and that is often used for explanation of tissue fluid
dynamics under physiological conditions, may then
obviously be inadequate in pathological conditions with
significant changes of crystalloid concentration. Second, in
physiological conditions there is a constant free flow,
Definition of Inflammation The Open Inflammation Journal, 2012, Volume 5 3

ANABOLISM

Monomers and lower Mwt substances + energy ===> polymers and higher Mwt Substances + water Eq. (1)

CATABOLISM
<===
being an equilibrium between catabolic and anabolic (117 Da for AA residue), about 1.7M AA residues are
processes under physiological conditions. This balance could incorporated in proteins per kg of lean mass. Normal tissue
generally be presented by the following equation: fluid osmolarity is 300 mOsm/L, or 0.3 Osm/L [13], that is
the osmolarity of 0.3 M of a nonionized substance. A
Here, anabolism and catabolism are considered in their
strict sense, not presenting processes concordant with or noticeable effect of increased osmotic pressure is evident
when the increase is about 50%, namely to about 450
supportive of either of them, such as oxido-reductions or
mOsm/L [38, 39]. In order for tissue osmolarity to rise by
fermentations. These other processes should be classified as
50%, it is sufficient that 0.15M/1.7M = 8.5% of AA residues
either catabolic or anabolic according to their influence upon
in proteins are liberated by proteolysis. On the other hand,
Eq. (1) equilibrium through their impact on reaction
normal tissue temperature variations are within 0.5 C, and
reactants. In particular, oxidative reactions, although often
considered as catabolic, should be regarded as principally the average tissue heat capacity is 3.47 kJ/kg  C [13]. Thus,
for a significant tissue temperature rise a heat release of at
anabolic, being the primary source of energy-rich
least 1.73 kJ/kg appears to be necessary. Taking 13 KJ/mole
compounds. Energy absorbed by anabolic reactions is
as the average energy of peptide bond hydrolysis [40], about
usually conserved by energy-rich compounds such as ATP,
0.13 M AA has to be released from proteins, or at least 7.6 %
while catabolic energy is released in form of heat, thereby
tissue protein should be hydrolyzed for this purpose. It
bringing about maintenance of constant tissue temperature in
homeoterms. Also, low molecular weight substances account appears that roughly the same proportion of protein (8%)
should be hydrolyzed in order for two major signs of
for the most part of the tissue osmotic pressure elevation
inflammation, edema and heat, to emerge. Experimental
generated in the course of catabolism. Whenever is the
studies with actual measurement of osmotic pressure in
metabolic balance sharply disturbed in favor of catabolism:
inflammatory edema have for example shown that it may
a) osmotic pressure rises, attracting extra fluid into the
rise by 37% [38] or up to 720% [41] in relation to control
tissue, edema; and b) free heat liberated from lytic and other
exothermic reactions such as decarboxylation, desamination values, figures that could by no means be explained by
Starling forces. The causative role of catabolism for
or glucose fermentation may significantly elevate tissue
generation of tissue hyperosmolarity in inflammation has so
temperature on its way out of the body. This is a general
far been postulated by several authors [42- 44], but such
mechanism that comprises phenomena of extracellular,
statements and their practical significance seem to have been
cellular and mitochondrial edema. Thus, the inflammatory
neglected by the scientific community. However, there are
process may be defined as a condition of acceleration of
tissue catabolism with such rate that 1) catabolism prevails two additional important factors that actually determine
tissue osmotic pressure and temperature. These are the rate
over anabolism, and 2) rise in the osmotic pressure is fast
of diffusion of lytic products from tissue for osmolarity and
enough to cause significant fluid accumulation with or
the rate of heat loss for tissue temperature. While the
without concomitant elevation of tissue temperature.
diffusion of lytic products may be significantly impaired by
Because a general prevalence of tissue catabolism over
the accompanying stasis, the heat loss rate is usually
anabolism is also observed in degenerative processes, the
distinction between inflammation and degeneration is based unaffected. Therefore, edema may appear even in the
absence of a noticeable calor. Dolor may be a result of a
only on the actual intensity of the process. Elusive nature of
direct irritant action of the causative factor, of action by
difference between degeneration and inflammation has
some mediators, or perhaps most commonly of direct
recently been clearly pointed out for the well studied case of
mechanical pressure of edematous fluid on surrounding
joint degeneration conditions, which show that in joint
nerves. For example, lack of compliance of the dental pulp is
cartilage mediators of inflammation are present with
degeneration that cannot meet the classical criteria for an obvious reason for a most intense pain that is often
experienced with dental caries. Finally, rubor would result
inflammation [34]. Also, substances analogous to mediators
from accumulation of red hemoglobin-containing
of inflammation (primarily proteolytic enzymes) are induced
erythrocytes in the course of vascular stasis and/or arteriolar
by interactions of C. elegans with bacterial pathogens and
dilatation. The presented definition is fully concordant with
not accompanied by classical signs of inflammation, but with
all classical macroscopic signs of inflammation. Should
clear noxious effects [35]. Therefore, so called mediators of
inflammation should rather be called mediators of perhaps cellular infiltration, the histological hallmark of
inflammation, or presence of a number of biochemically
degeneration as they are able to mediate both inflammatory
defined mediators be involved in a comprehensive definition
and non-inflammatory degenerative processes. For a
of inflammation? This question should also be considered
simplified illustration of possible quantitative characteristics
from its biochemical aspect. Although bearing a potentially
of the inflammatory process, let us first assume that
important catalytic role, cells and individual mediators are
catabolism is entirely represented by proteolysis, since
proteins are the main components of the dry weight of lean still non-essential for the biochemical process concerned. So
far, there appears to be no specific set of cells and mediators
tissue, where inflammation usually takes place. One kg of
that would include each type and case of the inflammatory
lean tissue contains on average about 200g of proteins [36,
process. Summarizing the definition above, it follows that
37], and taking 135 Da for amino acid (AA) mol. wt. average
4 The Open Inflammation Journal, 2012, Volume 5 Sran V. Stankov

inflammation is a direct consequence of a tissue injury that some signs depends on variations in the intensity of the
shifts the metabolic balance towards catabolism. process. Three signs, i.e. rubor, calor and dolor, may appear
Manifestations of enhanced catabolism in the course of an in the course of burns (as defined by their obvious etiology).
inflammatory process may be proteolysis [45-50], diminution However, with burns edema never occurs, even in case of the
of cellular space volume [51] or diminished oxidative most severe burns! This is evident from publicly available
metabolism [52, 53]. So it is a pathological process, not a macroscopic presentations of burns in review articles [63,
defensive reaction. But what is at the origin of the common 64] as well as from published pictures of histologic sections
belief that inflammation represents a defensive mechanism? of burnt tissue. Whereby, of course, one should not confuse
blisters with edema. Specifically, a blister represents a
Interrelationship Between Inflammation, Anti-inflammatory continuous fluid collection placed between tissue layers, so
Response and Burns
that it could be completely evacuated by puncturing it. In
Early investigators of inflammation in laboratory contrast, edema is a fluid interspersed within the tissue that
conditions observed the whole cascade of events upon the cannot be evacuated by a puncture, so that the tissue is both
isolated application of an irritant to a living tissue [4, 54, 55] macroscopically and histologically expanded. While edema
. This cascade also included, besides inflammation as a forms by attraction of water from primarily increased
pathological process as a direct consequence of the factor concentration of solutes, with burns water actually
applied, also the natural anti-inflammatory response, evaporates from the burnt tissue [65] and then condenses
essentially characterized by proteolysis inhibition [56-58]. below the nearest hydrophobic, water impermeable layer,
Anti-inflammatory response ensues after inflammation hence blisters. With second-degree burns such layer
reaches its climax, and represents a true defensive response represents the dermoepidermal junction, with more severe
that should in neither case be mixed with or ascribed to the burns it is the eschar. As the immediate consequence of such
latter. This relationship between the inflammatory process genesis of blisters, blister fluid is at least in the beginning
and the true defensive response is analogous to the with a poor protein content [66 , 67] and probably hypo or
relationship between inorganic material compression upon normoosmolar. Burnt tissues show hypovolemia [68, 69]
mechanical pressure and the elasticity of the material. The resulting from primary relative lack of water in the
latter phenomenon, partial restoration of volume and shape circulation. Based solely on the fact that there is no true
upon cessation of the external force, is the inherent property edema with burns, one may conclude that: a) burns are not an
of the material and not the consequence of the force itself, inflammatory process at all, and b) three mentioned
hence in neither case the integral part of the process of macroscopic signs appearing with burns are not specific for
compression. Each event observed upon tissue injury might inflammation. The fact that proteolysis and catabolism in
be either a part of inflammation as a direct consequence of general are also inhibited by externally applied heat by
the injury, or a part of the anti-inflammatory response as a reversion of the reaction thermodynamics (as is obvious from
true defensive response of the host tissue. These two Eq. 1) makes burns and anti-inflammatory response fully
opposing processes may be and often are uncoupled in compatible with each other, while putting burns in opposition
reality. Thus, inflammation with a dampened anti- to the inflammatory process. For a comparative review,
inflammatory response is present in cases of chronic processes representing integral components of inflammation,
inflammation, autoimmune diseases, hypersensitivity anti-inflammatory response and burns as an externally caused
reactions etc. The most obvious reason for an exaggerated process opposite to inflammation are given in Table 1.
inflammation (or the prevalence of the pro-inflammatory
component of inflammation in its broadest sense) is an CAUSES OF INFLAMMATION
intense or repeated cause of inflammation, the noxious The principal cause of inflammation is a pure mechanical
stimulus itself. It stimulates inflammation but not the anti- pressure, including blunt trauma [103,104], foreign bodies
inflammatory response, the latter being only temporarily but [105, 106], vibrations [107,108] and chronic pressure of low
not mechanistically related to the stimulus. On the other intensity [109, 110]. The basic mechanism of causing
hand, factors that directly stimulate biochemical reactions of inflammation by pressure is most probably through tissue
the anti-inflammatory response may do so even in the hypoxia. Namely, tissue oxygen as a liposoluble substance is
absence of previous inflammation, as shown for example in distributed mainly in lipids and hydrophobic proteinaceous
states of primary hypercorticism [59] or for peroxisome matter. Exposed to pressure, the volume of tissue water and
proliferator-activated receptor (PPAR) agonists [60, 61]. hydrophilic components as virtually incompressible remains
Besides the lack of discrimination of inflammation and anti- unchanged, while hydrophobic matter is compressed, with
inflammatory response, further sources of confusion in oxygen being squeezed out. Upon cessation of pressure, due
inflammation research were negligence of the true source of to its imperfect elasticity the tissue remains more or less
heat in inflammation (see above), as well as the concept that shrunk and therefore with a significantly diminished oxygen
inflammation represents a reaction to any injury. These led content for a certain period. Concomitant vascular changes
to the development of an utterly wrong experimental model may contribute to hypoxia especially if larger blood vessels
of inflammation, burns. With such a model, heat externally are involved. Hypoxia may then generate inflammatory
applied to a living tissue had been supposed to cause a changes through hypoxia-inducible factor (HIF) [125] and
process that would by all its characteristics be representative possibly other mediators, but the main mechanism may be
of inflammation [4, 27, 62]. According to the traditional the direct impairment of mitochondrially mediated anabolic
notion of inflammation, it has been assumed that all four processes and consequent metabolic shift towards
classic macroscopic signs may appear together in the course catabolism, a process meeting the definition of inflammation
of an inflammatory process, and that eventual absence of presented above.
Definition of Inflammation The Open Inflammation Journal, 2012, Volume 5 5

Table 1. Contrasting Features of the Inflammatory Process, the Natural Anti-Inflammatory Response and the Process of Burns
lammation Anti-inflammatory Response Burns
Appropriate references are given in brackets. When there are no available publications concerning a particular characteristic of a
process, a reasonable guess is presented with a question mark. The list of etiological factors is not exhaustive, only common
known causes of inflammation and burns are included. For each etiological factor of one of these two pathological processes,
there is another factor on the other side of the table that directly counteracts the effect of the former in an inorganic medium

Inflammation Anti-Inflammatory Response Burns


Contrasting Phenomenological Features

Stimulated anabolic reactions [e.g.


Stimulated catabolism [45-53] Catabolic inhibition [70, 71]
gluconeogenesis] [72, 73]
Enhanced oxidative metabolism [i.e.
Hypoxia [74-77] Hypoxia?
hypermetabolism] [78-82]
Hyperosmolarity [38, 41, 43, 44, 83] Hyperosmolarity? Hypo- or normoosmolarity?
Immediate-transient venular response [10, 84] Delayed-prolonged capillary response [27, 62]
Edema formation Edema resolution Blister or subeschar tissue fluid formation
Conversion of a necrotic process to apoptotic cell
Necrosis [85-87] Apoptosis [91-94]
clearance [88-90]
Lysis of colloids Coagulation of colloids
Immunostimulation [95-97] Immunosuppression [98-102]
Etiological Factors
Pressure [103-110] Spontaneous Radiation [111-113]
Cold [114,115] Heat [63, 64]
Bases [116] Acids [117]
Reducing substances [118,119] Oxidative substances [120]
Nucleophilic substances [121] Electrophilic substances [122]
Exothermic substances [123] Endothermic substances [124]

The second most important physical inflammagenic substance may influence the tissue in a purely physical way,
factor is cold. Cold is a well recognized etiological factor of by liberating or absorbing heat or adsorbing water. In
perniosis, a dermatitis upon cold exposure [114]. Also, cold particular, use of hydrophilic polymers such as carrageenan
may act through a frostbite [115]. In controlled experimental may first act by immediate water attraction, bringing about
conditions, cooling is capable of causing inflammatory edema of non-inflammatory origin, that later may or may not
edema [126-128], in concordance with the ability of heat be followed by inflammatory edema caused by the pressure
removal for stimulation of catabolism in Eq. (1). The made by the former. Therefore, for assessing biological
common belief that exposure to cold at least predisposes to effects one should be sure that a given substance reacts with
inflammatory conditions of infectious or noninfectious the observed tissue by a completely determined mechanism.
nature is therefore fully substantiated.
POSSIBLE ANTI-INFLAMMATORY STRATEGIES
Of chemical etiological factors, one should note bases
[116] and reducing substances [118, 119]. Effects of acids Once we confirm the biochemical essence of
are at best controversial, having in mind their procoagulative inflammation, what could we do to counteract it? Looking at
and therefore burn-like activity. While impairment of Eq. (1), the process could in principle be reversed on a
oxidative pathways may be a common mechanism of action thermodynamic basis either by reducing any of the reactants
for reducing substances, bases cause direct hydrolysis of on the right side or by enhancing those on the left. Direct
tissue constituents, favoring catabolism in a direct manner. change of substantial reactants is usually not desirable, since
we principally want to preserve the organic structure that
Inasmuch biocatalysts may be regarded as etiologic
existed before the disruption of metabolic balance. In
factors, one may mention proteolytic enzymes, other
hydrolytic enzymes and, finally pathogenic microorganisms, principle, each etiological factor that causes burns could be
used as an anti-inflammatory agent. One therapeutic
that in a functional sense and in their relation to the host
possibility that is apparent from the exposed equation is the
represent biocatalytic complexes with hydrolytic enzymes
addition of heat to the inflamed tissue. Thermotherapy has
acting as their major factors of pathogenicity.
already been developed as a purely empirically based
When assessing effects of chemical substances one procedure [129], but for unknown reasons therapists have
should be very cautious since a single substance may carry been reluctant to use this technique for treatment of acute
different functional groups that could in different tissues inflammatory conditions. Thermotherapy could be done
react differently, sometimes even in opposed directions. For either by a myriad of physical modes of heat application, or
example, a substance may at the same time be reductive and by application of an endothermic substance that would
acidic, oxidative and basic, etc. Also, a concentrated release heat locally in a coupled reaction. Physical methods
6 The Open Inflammation Journal, 2012, Volume 5 Sran V. Stankov

have the advantage of a relative ease of site selective heat mediators as catalysts of the process, by analogy to chemical
delivery, while chemicals could usually be directed, except catalysts, do not define the process itself nor determine its
for topical application, only by local injection. Besides, the direction. The presented definition should contribute to the
intensity of the action of a substance is absolutely limited by basic, essential understanding of the inflammatory process.
its maximal attainable concentration. On the other hand, Once its important practical consequences are explored in
chemical substances may more naturally act on inner detail, it should yield more effective anti-inflammatory
mucosal surfaces of the gastrointestinal or respiratory tract. therapeutic and prophylactic strategies.
Both modalities (physical factors and chemicals) could of
course be combined, if feasible. Preclinical studies would be CONFLICT OF INTEREST
needed to adjust the dosing regimen before adequate,
The author confirms that this article content has no
carefully planned and controlled clinical trials are initiated. conflicts of interest.
Thermotherapy alone may not be sufficient for extreme
cases, but would on average enhance the overall therapeutic ACKNOWLEDGEMENT
success rate without any danger of inducing burns and with
an easily manageable risk of hyperthermia on a prolonged The author expresses his gratitude to the following
exposure. In cases where the cause of inflammation acted on voluntary reviewers for their valuable remarks and
a single occasion, anti-inflammatory therapy alone would be suggestions:
sufficient, but when the cause acts repeatedly or habitually 1. Prof. Alexander Boldyrev, Department of
additional measures are necessary to prevent its further Biochemistry, School of Biology, MV Lomonosov
action. In practical terms, one should well discriminate Moscow State University, Moscow, Russia,
between true inflammation on one hand and burns or
hyperthermia on the other. Diagnosis of true inflammation is 2. Prof. Dr. Artur Bauhofer, Institute of Theoretical
unambiguously supported by the presence of catabolically Surgery, Philipps-University Marburg, Marburg,
generated edema as the only specific macroscopic sign. Germany,
However, edema may be present only at a microscopic scale
3. Prof. Dr. Giuseppe Pintucci, Department of
and sensitive noninvasive tests detecting the process or
Cardiothoracic Surgery, New York University School
products of hydrolysis could be performed routinely.
of Medicine, New York, USA,
Because of the opposing nature of burns and inflammation,
adequate therapeutic measures for burns should be quite 4. Prof. Dr. Ron Mathison, Faculty of Medicine,
different from the anti-inflammatory treatment. University of Calgary, Calgary, Canada, and
Besides reversion of thermodynamics, one might also be 5. Prof. Dr. Dejan Cvjetkovi, Clinic for Infectious
guided by another therapeutic principle that is currently so Diseases, Clinical Center of Vojvodina, Novi Sad,
widely used in pharmacotherapy, namely by catalysis Serbia.
regulatory action. Both principles could and should be
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Received: May 16, 2012 Revised: July 03, 2012 Accepted: July 15, 2012
Sran V. Stankov; Licensee Bentham Open.
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